Ezra's trip to the ENT

Ezra and I went to Lubbock today to see Dr. Demke.  We saw Dr. Demke as part of a cleft palate clinic last February and he is the one who recommended that we have the scope done to see what exactly his palate is doing.  Today was our follow up visit from that scope.

Before Dr. Demke saw Ezra, they took E's height and weight.  I guess I am behind, I had his weight at about 27 lbs.  He stepped on the scale and it said he weighed 32 pounds!  And he is 38 inches tall!  Wow!  He has been home two years this month and has gained 12 pounds and grown more than 7 inches!  Unbelievable!

The scope revealed just what we had suspected: Ezra's palate is neither moving up and down, or side to side as it is supposed to when he speaks.  The only way to fix that is to do a pharyngeal flap procedure, or P-flap.  More on that in a bit...

During the exam, we also learned that both of Ezra's ear tubes have come out. Normal and to be expected, most ear tubes fall out on their own within a year of placement.  Dr. Demke wanted a hearing test to see if we needed to replace the tubes.  The tempanogram showed that he has lots of fluid behind both eardrums, and the hearing test revealed that his hearing is on the low end of normal.  He has some hearing loss, but not a lot.  Dr. Demke said that replacing the tubes *might* help his hearing but he was not sure enough to just go ahead and automatically replace them.  He left that decision in our court.

As the doctor explained to me the P-flap procedure, he told me that the first step for Ezra will be to take his tonsils out.  Since Ezra's palate is not doing any of the work it needs to do, the flap they build will have to be very wide.  So wide that his tonsils will be in the way.  They need to come out.  After he has had a few months to heal from the tonsillectomy, Dr. Demke will perform the P-flap surgery.

What is a pharyngeal flap???  What does this do for Ezra???  Right now when Ezra talks, the palate does not move to close off the airway behind his nose.  This means that all of the air that is supposed to come out of his mouth when he talks instead escapes through his nose.  Try talking through your nose.  Yeah, you can't even understand yourself!  No wonder no one can understand the poor kid!

A P-flap is a procedure in which a portion of tissue from the back of the throat is partially removed.  The "flap" is still attache to the throat, but the free end is then swung forward and attached to the palate.  This partially blocks off the airway at the back of the throat, the area where the sinuses connect to the throat. He said that if Ezra does not snore now, he probably will after this procedure!

Feel free to google, just beware that some of the images are rather gross.  This picture shows the end result without all the blood and gore! The picture here does not show that there is space on the sides of the flap to allow some air to go through, otherwise Ezra would not be able to breathe through his nose.  We are hoping that the end result of this procedure is that MOST of the air goes through his mouth when he talks and that we can understand our precious boy!

For now we will focus on getting him through the tonsillectomy.  We have it scheduled for November 12 but then realized that Asa's MRI is that same week in Ft Worth, so we need to figure out if we need to be dragging Ezra all over Texas the day after his tonsils come out.  I am leaning towards: NOT! 

Please be praying for wisdom in the timing of all of these procedures and surgeries!  We are so thankful to have found Dr. Demke though and that we can get Ezra the care he needs at a facility much closer than Ft Worth!